- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.00 / $1,911.78 / $8,229.00
| Facility | | $1,241.00 | $1,911.78 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,923.72 / $7,537.12 / $11,845.28
| Facility | | $3,923.72 | $7,537.12 | $11,845.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,699.22 / $2,332.27 / $2,690.44
| Facility | | $1,699.22 | $2,332.27 | $2,690.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,053.92 / $2,053.92 / $2,053.92
| Facility | | $2,053.92 | $2,053.92 | $2,053.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |